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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma: A multicenter study
Jongman Kim, Dong-Jin Joo, Shin Hwang, Jeong-Moo Lee, Je-Ho Ryu, Yang-Won Nah, Dong-Sik Kim, Doo-Jin Kim, Young-Kyoung You, Hee-Chul Yu
Jongman Kim, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Dong-Jin Joo, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
Shin Hwang, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Jeong-Moo Lee, Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
Je-Ho Ryu, Department of Surgery, Pusan National University College of Medicine, Busan 50612, South Korea
Yang-Won Nah, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Dong-Sik Kim, Department of Surgery, Korea University College of Medicine, Seoul 02841, South Korea
Doo-Jin Kim, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, South Korea
Young-Kyoung You, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul 06591, South Korea
Hee-Chul Yu, Department of Surgery, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Author contributions: Kim J designed the research study, analyzed and interpreted the data, wrote the manuscript; Joo DJ, Hwang S, Lee JM, Ryu JH, Nah YW, Kim DS, Kim DJ, You YK, and Yu HC collected the data and validated the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Samsung Medical Center Institutional Review Board (IRB), No. SMC-2019-09-147-006.
Informed consent statement: The requirement for informed consent was waived by the IRB.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are not publicly available to assure the privacy of research participants but are available from the corresponding author (Jongman Kim) upon reasonable request at jongman94@hanmail.net.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jongman Kim, MD, PhD, Professor, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. jongman94@hanmail.net
Received: December 12, 2022
Peer-review started: December 12, 2022
First decision: December 27, 2022
Revised: January 3, 2023
Accepted: April 19, 2023
Article in press: April 19, 2023
Published online: July 27, 2023
ARTICLE HIGHLIGHTS
Research background
Patients with combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) tumors are not traditionally considered for liver transplantation (LT) because single centers with few cases have previously reported poor outcomes; however, several small single-center cohort studies showed satisfactory outcomes after LT for cHCC-CC equivalent to those attained for hepatocellular carcinoma (HCC). The role of LT has been investigated in several retrospective studies that included patients diagnosed incidentally during pathological examination of the explant. The variation in results among patients with cHCC-CC suggests that LT should be considered only in select cases.
Research motivation
Data on clinicopathologic presentation, prognostic factors, and outcomes for LT in cHCC-CC patients are lacking because cHCC-CC is rare, and few studies have been published. To overcome the limitations of single-center and small-volume cases, we collected and analyzed data to evaluate the utility of LT for cHCC-CC from high-volume LT centers in Korea.
Research objectives
We compared the characteristics between living donor LT (LDLT) patients with HCC and LT patients with cHCC-CC before and after propensity score matching and identified the risk factors for tumor recurrence and death after LT in cHCC-CC patients.
Research methods
We performed a retrospective analysis of patients who were diagnosed with cHCC-CC in their postoperative pathology reports and who underwent LT at any of nine Korean medical centers between January 2000 and December 2018. Patients who received LDLT for HCC at Samsung Medical Center from January 2013 to March 2017 were selected as the control group. Recipients < 18 years, re-transplantation cases, and patients who received multiorgan grafts were excluded.
Research results
Cumulative disease-free survival and overall survival in the cHCC-CC group were significantly worse than in the HCC group both before and after matching. Extrahepatic recurrence incidence in the cHCC-CC group was higher than that in the HCC group (75.5% vs 33.3%, P < 0.001). Multivariate analysis demonstrated that the cHCC-CC group had significantly higher rates of tumor recurrence and death compared to the HCC group. In cHCC-CC subgroup analysis, frequency of locoregional therapies > 3, tumor size > 3 cm, and lymph node metastasis were predisposing factors for tumor recurrence in multivariate analysis. Only a maximum tumor size > 3 cm was a predisposing factor for death.
Research conclusions
The poor prognosis of patients diagnosed with cHCC-CC after LT can be predicted based on the explanted liver. Frequent regular surveillance for cHCC-CC patients should be required for early detection of tumor recurrence.
Research perspectives
Research is needed to determine how cHCC-CC patients are diagnosed and when to perform LT for the best outcome.
